Oktay ERGENE, Cem NAZLI, Fatih TOPTANCI, Hamza DUYGU, Uğur KOCABAŞ, NİHAN KAHYA EREN, Zehra İlke AKYILDIZ, Rida BERİLGEN, Sefa Nuri AKDEMİR

Karotis arter stentlemenin kısa dönem klinik sonuçlara etkisi ve restenozun değerlendirilmesi

Amaç: Karotis stentlemede restenoz ve uzun dönem sonuçlarla ilgili veriler sınırlıdır. Bu çalışmanın amacı semptomatik ağır karotis arter darlıklı hastalarda stentleme işleminin klinik sonuçlara ve restenoz oranlarına etkisini araştırmaktır. Gereç ve yöntem: Çalışmaya Kalp Damar Cerrahisi, Kardiyoloji ve Nöroloji ortak konseyinde stent implantasyonu kararı alınan 20 hasta (yaş ortalaması 68±7 yıl, 11’i erkek) alındı. Hastalar perioperatif (ilk 30 gün ) ve birinci yıl sonunda hem klinik hem de Doppler ultrasonografi ile değerlendirilerek kardiyovasküler olay sıklığı ve restenoz oranları değerlendirildi. İzlemde karotis Doppler ultrasonografi ile %50 ve üzeri darlığa karşılık gelen instent zirve akım hızının ≥224 cm/sn olması restenoz olarak kabul edildi. Bulgular: Hastalarda ek hastalık olarak 14’ünde koroner arter hastalığı, 3’ünde periferik arter hastalığı, 2’sinde kronik böbrek yetmezliği, 2’sinde ise kalp yetersizliği mevcuttu. İşlemde kullanılan stentlerin çapı 6 ile 8 mm arasında, stent uzunluğu ise 30 ile 40 mm idi. Beş (%25) hastaya predilatasyon yapılırken, postdilatasyon 19(%95) hastaya uygulandı. Postdilatasyon sonrası hiçbir hastada ≥%30 rezidüel darlık izlenmedi. İşlem başarısı %100’dü. İşlem sonrası periprosedürel olay kapsamında 1(%5) hastada geçici iskemik atak gelişti. Otuz günlük ve bir yıllık takiplerde inme, miyokard infarktüsü veya ölüm görülmedi. Hiçbir hastada restenoz izlenmedi. Diyabet ve kalp yetersizliği restenoz öngördürücü faktörleri olarak saptandı. Sonuç: Karotis arter stentleme iyi seçilmiş olgularda kısa dönemde etkin ve güvenilir bir yöntemdir. Restenoz karotis arter darlığında işlem başarısını etkileyen kısıtlayıcı bir faktör olarak görünmemektedir.

The effects of carotid artery stenting on short-term clinical outcomes and evaluation of restenosis

Objectives: Data on restenosis and long-term outcomes of carotid stenting are limited. The aim of this study was to investigate cardiovascular effects of carotid stenting on clinical outcome and restenosis in patients with symptomatic severe carotid artery stenosis. Materials and methods: Twenty patients (mean age: 68±7 years, 11 male) who have been decided to perform stenting in joint Committee of Cardiology, Cardiovascular Surgery and Neurology Clinics were included.Patients were evaluated both clinically and Doppler ultrasonographically for frequency of cardiovascular events and restenosis. Restenosis is defined as the reapperance of stenosis with a diameter reduction of ≥%50 with peak systolic velocity higher than 224 cm/s. Results: Comorbidities in patients were; coronary artery disease in 14, peripheral artery disease in three, and both chronic renal failure and congestive heart failure in two. Stent diameters were ranged from 6 to 8 mm, and stent lengths were 30 and 40 mm. During the procedure 5 patients had predilatation and 19 had postdilatation. None of the patients had >%30 resudial stenosis after the procedure. All procedures were technically successful. After the procedure only one transient ischemic attack was seen. There were no restenosis, myocardial infarction, death or stroke at 30th day end of the first year of follow up. Diabetes and heart failure were found as predictors for restenosis. Conclusion: In highly selected cases, carotid artery stenting is an effective and safe method in the short term. Restenosis did not seem to be a restricting problem for the success of carotid artery stenting.

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